1 / 32

Parenteral Nutrition

Parenteral Nutrition. Made simple…. in 15 minutes Jon Shaffer Intestinal Failure Unit Hope Hospital. Parenteral nutrition. Importance of malnutrition Nutrition assessment Nutrition teams Indications Access Prescribing Monitoring. Parenteral nutrition. Importance of malnutrition

liona
Télécharger la présentation

Parenteral Nutrition

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Parenteral Nutrition Made simple…. in 15 minutes Jon Shaffer Intestinal Failure Unit Hope Hospital

  2. Parenteral nutrition • Importance of malnutrition • Nutrition assessment • Nutrition teams • Indications • Access • Prescribing • Monitoring

  3. Parenteral nutrition • Importance of malnutrition • Nutrition assessment • Nutrition teams • Indications • Access • Prescribing • Monitoring

  4. CONSEQUENCES OF MALNUTRITION DIMINSHED QUALITY OF LIFE INCREASED CLINICAL COMPLICATIONS POORER OUTCOME INCREASED COSTS

  5. Malnutrition on admission –Sweden 382 pts • Infection • Surgery • Internal medicine • Oncology • Well nourished 73 % • Moderately malnourished 20 % • Severely malnourished 7 %

  6. Parenteral nutrition • Importance of malnutrition • Nutrition assessment • Nutrition teams • Indications • Access • Prescribing • Monitoring

  7. Nutritional assessment • Problem • No “blood urea “ for malnutrition • Risk scores v malnutrition • Multiple examples • Lack of a Gold Standard • Validation

  8. Nutritional screening • ALBUMIN • Long half life • Overly sensitive- liver/renal disease • Reduction – redistribution • Slow to react with recovery • “ negative acute phase protein”

  9. Nutritional screening • Subjective Global Assessment • Pt questionse.g weight loss • diet changes • GI symptoms • Physical appearance- • loss of fat • muscle wasting • Grading • A Well nourished • B Moderately malnourished • C Severely malnourished • Detsky 1987

  10. Parenteral nutrition • Importance of malnutrition • Nutrition assessment • Nutrition teams • Indications • Access • Prescribing • Monitoring

  11. Nutrition support teams • Appropriate screening /referral • Appropriate nutrition support • Education/training – staff and pts • Cost effective • PN x10 v EN • Better outcomes • Reduced complications • Bowling 2002

  12. Efficacy of nutrition support teamse.g. catheter sepsis rates

  13. Parenteral nutrition • Importance of malnutrition • Nutrition assessment • Nutrition teams • Indications • Access • Prescribing • Monitoring

  14. Appropriateness – varies • Few ABSOLUTE indications • 1. Intestinal Failure • 2. If the gut works – use it • 3. Enteral preferable

  15. If the gut works……1 • Technology -- 1970’s—1990 • Parenteral > Enteral • Better catheters/ better feeds/better research • Industry/ Surgery driven • Most - Surgical/Intensive care/Cancer

  16. If the gut works……2 • 1990’s • Enteral tubes especially PEG’s • Medical > Surgical • Erosion of traditional markets e.g. Pancreatitis, ICU

  17. Enteral ? preferable • Simpler • Less complications • Cheaper • Equieffective

  18. Parenteral nutrition • Importance of malnutrition • Nutrition assessment • Nutrition teams • Indications • Access • Prescribing • Monitoring

  19. IV ACCESS • Peripheral - short term • Midline - short/medium • PICC ( Peripherally inserted central line ) -medium • Central – medium/long term • Central tunnelled – ultra long term HPN

  20. Prescribing • Standard bags • A la carte • All in one bags • Re-feeding syndrome Po4, K

  21. Design of Regimen • Osmolality peripheral < 900 mosmol/L, (1800kcals) PICC < 1200 mosmol/L (2000kcals) Central < 1700 mosmol/L (> 2000kcals)

  22. Fluid • 30-35mls/kg body weight (adjust for age)

  23. Energy • Normal to provide a ratio of • Glucose: fat 50:50 or 60:40 • Overfeeding can result in lipogenesis, fatty infiltration of the liver

  24. Nitrogen • Range from 0.17-0.3gN/kg • Rarely give >14g / day • Need to ensure maximal metabolic effect of protein – 200kcals / gN • I.e. excess nitrogen = extra calories

  25. Vitamins and Minerals • Water soluble • Fat Soluble • Trace Elements

  26. Parenteral Nutrition Regimen

  27. Requirements • Energy = 8.1x45+656 =1020 + (153kcals)15% activity + (153kcals) 15 % stress + 500kcals = 1826kcals • Nitrogen = 0.2g/kg = 9gN • Fluid = 4 L (35mls/kg (1575mls) + losses 2.5L) • Na 295mmol (1mmol / kg, GI losses 250mmol/L) • K 45mmol (1mmol / kg) • PO 22.5mmol (0.5-0.7mmol/kg) • Mg 4.5mmol (0.1-0.2mmol/kg) • Ca 4.5mmol (0.1-0.2mmol/kg)

  28. Monitoring

  29. BAPEN British Association Enteral & Parenteral Nutrition

More Related